Sally Pipes: Obamacare may put end to doctor-patient relationship

February 26, 2013|By Sally Pipes

Are the days of the traditional family doctor coming to an end?

In the almost three years since Obamacare became the law of the land, more and more physicians have expressed concern about the future of their profession. Consequently, they've been leaving private practice and opting instead for the likes of cash-only concierge medicine or salaried positions at hospitals.

A new era of assembly-line medicine is before us. Thanks to Obamacare, the traditional doctor-patient relationship may soon be a historical relic. And that's bad news for the quality of patient care.

Physicians have long harbored misgivings about Obamacare. According to a 2011 report from Deloitte Consulting, nearly 70 percent are pessimistic about the future of the medical profession because of the healthcare law.

A survey released last year by the non-partisan Doctor Patient Medical Association painted an even bleaker picture, revealing that 83 percent of physicians have thought about leaving their practices because of Obamacare.

One of the chief concerns of doctors is the law moves American health care away from the standard fee-for-service model and toward a "bundled payment" system. Under this scheme, doctors and hospitals aren't paid for the services they actually provide. Instead, they're given a lump sum for each "episode of care." If treatment costs more than the bundled payment, then doctors have to absorb the difference.

It's easy to see why physicians aren't pleased. As New York University School of Medicine professor Dr. Marc Siegel recently wrote, "Under Obamacare, we're being asked to provide the same high-tech service with more restrictions and regulations to more patients and to be paid less for doing so."

Obamacare will only aggravate the administrative headaches that doctors have long faced. So some doctors are moving to a simpler approach — concierge medicine.

Under such an arrangement, patients pay a monthly fee to keep a physician on retainer. Physicians are then able to practice free of government or insurance-company meddling.

A recent survey of 14,000 doctors by the staffing firm Merritt Hawkins found that 9.6 percent of physicians who own practices were planning to change to a concierge model.

Merritt Hawkins predicts 75 percent of physicians will be employed by hospitals in 2014.

Worse still, some doctors are joining Accountable Care Organizations, which are networks of doctors and hospitals that aim to deliver coordinated care to patients. These new entities are at the center of Obamacare's efforts to eliminate waste and duplication in health care — and thus bring down costs.

In reality, ACOs bear a striking resemblance to the Health Maintenance Organizations of the 1990s, which Americans largely rejected.

Patients didn't like having insurance companies dictate the terms of their treatment according to one-size-fits-all models.

But with government in charge of the ACOs, they may not have a choice.

In short, Obamacare has made it so challenging for doctors to operate private practices that many have decided not to do so anymore. And as doctors become salaried workers, their allegiances will shift. The interests of their employers will supplant those of their patients.

Fortunately, Americans determined to receive personalized care aren't without options. In addition to concierge practices, another tactic growing in popularity is medical tourism — traveling abroad for treatments and procedures, often at more affordable prices. This year, three-quarters of a million Americans will travel outside the country for non-urgent care.

The medical tourism group Patients Beyond Borders estimates that Americans can save 25 to 40 percent on their medical bills by traveling to Brazil. For Costa Rica, it's 45 to 60 percent. And in Thailand, the savings can reach 70 percent.

Thanks to Obamacare, the traditional doctor-patient relationship is on its last legs here in the United States. But it's alive and well abroad. In increasing numbers, Americans are finding that out for themselves.

Sally Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute.